Provider Demographics
NPI:1366673105
Name:JMJ ENTERPRISE, LLC
Entity Type:Organization
Organization Name:JMJ ENTERPRISE, LLC
Other - Org Name:FRESH START HOME FOR CHILDREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:DERONN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-271-6982
Mailing Address - Street 1:2020 TEXTILE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5857
Mailing Address - Country:US
Mailing Address - Phone:336-271-6982
Mailing Address - Fax:336-271-6982
Practice Address - Street 1:2020 TEXTILE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5857
Practice Address - Country:US
Practice Address - Phone:336-271-6982
Practice Address - Fax:336-271-6982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-857251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services